MP001: Low acuity emergency department access: are other options available?

Introduction: Patients with low-acuity (CTAS level IV and V) complaints often use the emergency department (ED) to access care. This has often been attributed to lack of a primary care (PC) provider. However, simply being registered with a primary care practitioner may not prevent low acuity ED presentation. There is some evidence that a lack of timely access to primary care may contribute to low acuity ED presentations. The Wait Time Alliance, a group of Canadian physicians and their respective professional associations, has recently set a benchmark of same day access to family doctors. It is unclear if this benchmark has been achieved in all jurisdictions. Methods: We performed linked cross sectional surveys to quantify the number of people presenting to a tertiary hospital ED (with 56,000 annual visits) with non-urgent problems who felt unable to access PC. PC practices were also surveyed to assess access using the metric of time to third next available appointment. Sample size calculations were completed. Descriptive statistics were reported. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 89 patients met eligibility criteria. 32 (35.9%) reported that the wait to see their PC provider was “too long”. 45 (50.5%) patients did not contact their PC office prior to ED presentation. 46 of 72 PC physician surveys were returned; a response rate of 63.8%. The mean time to third next available appointment in the region was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). Conclusion: Fifty percent of low acuity patients did not attempt to access their PC provider prior to ED presentation. The benchmark of same day access to primary care has not been achieved in many practices in this region. Initiatives to promote primary care access would benefit both patients and providers.

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P084: Waiting makes me sick: is it time for formal triage in primary care?

CJEM ◽

10.1017/cem.2016.260 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S106-S106

Author(s):

J. MacKay ◽

P.R. Atkinson ◽

M. Howlett ◽

E. Palmer ◽

J. Fraser ◽

...

Keyword(s):

Primary Care ◽

Wait Time ◽

Patient Survey ◽

Wait Times ◽

Cross Sectional ◽

Triage System ◽

Care Appointment ◽

Open Scheduling ◽

Primary Care Practices ◽

Advanced Access

Introduction: Patient morbidity and mortality are influenced by delay in access to care and lack of continuity of care. Patients frequently present to the emergency department (ED) for care despite being registered with a primary care (PC) provider. Advanced access is an open scheduling system promoted by the College of Family Physicians of Canada that triages primary care (PC) patients to be seen within 24 hours, reducing care delay. We wished to determine the prevalence of formal triage systems in PC appointment allocation. Methods: We performed linked cross sectional surveys to quantify the number of ambulatory patients presenting to a tertiary urban ED (with an annual census of 56,000 visits) who felt unable to access primary care. PC practices were also surveyed to assess use of formal triage methods and measure access using the metric of time to third next available appointment. Descriptive statistics were calculated. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 324 patients reported reasons for their ED visit. Perception that wait time for PC was “too long” was reported in 73/324 (23%); 86% reported wait times of greater than 48 hours. The PC practice response rate was 63.8% (46/ 72). The mean time to third next available appointment was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). No PC practice reported utilizing a formal triage system when booking appointments. Conclusion: No primary care practices in the surveyed region used a formal triage system to allocate appointments, despite a range of wait times that extended up to 50 days. The safety of primary care appointment allocation may be improved with introduction of a formal triage system, especially if overall wait times cannot be reduced.

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Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

International Journal of Emergency Medicine ◽

10.1186/s12245-019-0254-7 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Nawaf Alhabdan ◽

Faisal Alhusain ◽

Abdulkareem Alharbi ◽

Muatassem Alsadhan ◽

Moath Hakami ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Physicians ◽

Waiting Times ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Care Physician ◽

Emergency Department Visits ◽

Cross Sectional ◽

Validated Questionnaire

Abstract Background In recent years, there has been an increased utilization of emergency departments (EDs) in many countries. Additionally, it is reported that there are major delays in delivering care to ED patients. Longer waiting times are associated with poor patient satisfaction, whereas an understanding of the triage process increases satisfaction. This study aimed to assess ED visitor’s awareness of the triage procedure and their preferences regarding delayed communication. Methods Cross-sectional study of King Abdulaziz Medical City – Emergency Department visitors using a previously validated questionnaire (Seibert 2014) which was translated to Arabic, piloted, and then used for this study. Results A total of 334 questionnaires were returned. The mean age of respondents was 33 years. Regarding primary care physicians, only 16% of respondents said that they have one. About 21% of those tried to communicate with them before coming to the ED. Even though only 11% of respondents knew exactly what triage is, 51% were able to correctly explain why some patients are seen before others. Statistical analysis did not show any factors that are associated with increased knowledge of triage. Most respondents (75%) want to hear updates regarding delays with 69% of them preferring to be updated every 30 min. Conclusions This study showed that the majority of patients do not know what triage means and that most of them want to know how the ED works. Moreover, a lot of respondents said that they do not have a primary care physician. These results support increasing patient awareness by education and involving them if any delay happens.

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Greater access to primary care may reduce emergency department use

PsycEXTRA Dataset ◽

10.1037/e556202006-026 ◽

2005 ◽

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Department Use ◽

Access To Primary Care

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The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

Canadian Journal of Nursing Research ◽

10.1177/08445621211014421 ◽

2021 ◽

pp. 084456212110144

Author(s):

Behdin Nowrouzi-Kia ◽

Mary T. Fox ◽

Souraya Sidani ◽

Sherry Dahlke ◽

Deborah Tregunno

Keyword(s):

Emergency Department ◽

Role Conflict ◽

Acute Care ◽

Acute Care Hospitals ◽

Cross Sectional Survey ◽

Eligibility Criteria ◽

Cross Sectional ◽

Medical Unit ◽

Scale Scores ◽

Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

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Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v8i2.28839 ◽

2021 ◽

Vol 8 (2) ◽

pp. 105-111

Author(s):

Sunil Adhikari ◽

Suraj Rijal ◽

Darlene Rose House

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Variceal Bleeding ◽

Clinical Presentation ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Hospital ◽

Clinical Profile ◽

Ulcer Bleeding ◽

Cross Sectional ◽

Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

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The association between febrile convulsion in children and chronic hyperventilation in parents

Paediatrica Indonesiana ◽

10.14238/pi42.6.2002.239-42 ◽

2002 ◽

Vol 42 (6) ◽

pp. 239

Author(s):

M. Widiastuti Samekto ◽

I Gusti Putu Ardana

Keyword(s):

Hospital Setting ◽

Prevalence Ratio ◽

Febrile Convulsion ◽

Tertiary Hospital ◽

Hyperventilation Syndrome ◽

Genetic Trait ◽

Eligibility Criteria ◽

Cross Sectional ◽

Table Analysis ◽

Cross Sectional Design

Background Febrile convulsion and chronic hyperventilation syndrome (spasmophilia) are suspected to share the same root of pathophysiology, a genetic trait abnormality related to ion channel that could cause neuronal hyperexcitability.Objective To determine the prevalence ratio of parents with chronic hyperventilation syndrome between two groups of children with and without febrile convulsion.Methods A cross-sectional design study was used, with a tertiary hospital setting (Kariadi Hospital). Participants were selected consecutively based on eligibility criteria. Febrile convulsion was diagnosed based on a modified Livingstone criteria. Chronic hyperventilation syndrome in parents was determined using the clinical diagnostic test of spasmophilia (88.4% sensitivity and 6 1.6% specificity). Statistical calculations were conducted with two by two table analysis and within the 95% confidence interval.Results Sixty-two children (mean age 18 months) who met the eligibility criteria were included. The parents' mean ages were 33 years (father) and 29 years (mother). The prevalence ratio of father, mother and both parents with chronic hyperventilation between the febrile convulsion group and the non-febrile convulsion group were 2.56 (95% CI 0.53 to 12.31), 6.19 (95% CI 1.70 to 22.6) and 18.7 (95% CI3.07 to 113.9), respectively.Conclusion Febrile convulsion can be anticipated in children of parents who suffer from chronic hyperventilation syndrome.

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Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

Journal of Primary Care & Community Health ◽

10.1177/2150132720926276 ◽

2020 ◽

Vol 11 ◽

pp. 215013272092627

Author(s):

Julia Ellbrant ◽

Jonas Åkeson ◽

Helena Sletten ◽

Jenny Eckner ◽

Pia Karlsland Åkeson

Keyword(s):

Primary Care ◽

Emergency Department ◽

Patient Characteristics ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

University Hospital ◽

Pediatric Emergency Department ◽

Hospital Data ◽

Cross Sectional ◽

Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

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